Structural racism and health inequities in the USA- evidence and interventions.pdf

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Vol 389 April 8, 2017 1453SeriesAmerica: Equity and Equality in Health 3Structural racism and health inequities in the USA: evidence and interventionsZinzi D Bailey, Nancy Krieger, Madina Agénor, Jasmine Graves, Natalia Linos, Mary T BassettDespite growing interest in understanding how social factors drive poor health outcomes, many academics, policy makers, scientists, elected ocials, journalists, and others responsible for defining and responding to the public discourse remain reluctant to identify racism as a root cause of racial health inequities. In this conceptual report, the third in a Series on equity and equality in health in the USA, we use a contemporary and historical perspective to discuss research and interventions that grapple with the implications of what is known as structural racism on population health and health inequities. Structural racism refers to the totality of ways in which societies foster racial discrimination through mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care, and criminal justice. These patterns and practices in turn reinforce discriminatory beliefs, values, and distribution of resources. We argue that a focus on structural racism offers a concrete, feasible, and promising approach towards advancing health equity and improving population health.IntroductionRacial and ethnic inequalities, including health inequities, are well documented in the USA (table),1–5and have been a part of government statistics since the founding of colonial America.6–8However, controversies abound over explanations for these inequities.6–8In this report, we offer a perspective not often found in the medical literature or taught to students of health sciences, by focusing on structural racism (panel 1)9–11as a key determinant of population health.9,10,12,13To explore this determinant of health and health equity, we examine a range of disciplines and sectors, including but not limited to medicine, public health, housing, and human resources. Our focus is the USA.Although there is growing interest in understanding how social factors drive poor health outcomes,14and directed investigation in social science and social epidemiology into the interconnected systems of discrimination,9,10,12,13many academics, policy makers, scientists, elected ocials, and others responsible for defining and responding to the public discourse remain resistant to identify racism as a root cause of racial health inequities.9,10,13 For example, in a Web of Science search done on Sept 7, 2016, with the term “race” in conjunction with “health”, “disease”, “medicine”, or “public health”, 47 855 articles were retrieved. However, when “race” was replaced by “racial discrimination”, only 2061 articles were located, and only 1996 articles were found when it was replaced by “racism”. Furthermore, when “race” was replaced by “structural or systematic racism”, only 195 articles were identified (ie, 0·4% of those identified

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